Considering the financial constraints already in place, and the likelihood that there will be continuing reductions in federal grant funds for preparedness, the challenge facing U.S. hospitals and other healthcare facilities to do more with less has perhaps never been greater. More specifically, in preparedness planning and operations, very few U.S. health systems are financially stable enough to be able to stockpile materials, and/or train personnel, with the funds available from “discretionary” budgets to the extent that the health systems themselves feel reasonably comfortable and/or fully prepared for the next major mass-casualty incident or event.
Making the situation worse is that one unexpected byproduct of a long-term lull in disasters often might be an understandably lower focus, by hospital administrators, on future “what if” emergencies. Even when not faced with a pandemic flu, a natural disaster, or a terrorist event in the foreseeable future – events that might never happen – hospital CEOs must still cope with the problem of balancing shrinking revenue against the cost of routine daily operations.
In those circumstances, a request from the hospital CEO to cut budgets by another 15 percent, or face layoffs, will almost always receive greater and more immediate attention from administrators than would the less likely possibility of a “dirty bomb” explosion in New York City’s Times Square. The real question then becomes this: “How do hospitals continue to be ready for a major incident when their focus starts to wane?”
Acute Unplanned Events
Putting that question, and that problem, into clearer focus is the fact that one apparently deranged gunman, acting alone, opened fire in a crowded movie theater in Aurora, Colorado, on 20 July 2012, killing 12 and wounding dozens of others. That horrific incident served as a wake-up call to health administrators throughout the United States for many reasons – the most obvious being that it was clear proof that it does not take a hurricane, tornado, or a terrorist attack too seriously and immediately affect an entire community.
As has been seen in other recent mass-casualty events in various areas of the country – e.g., the Columbine, Virginia Tech, and Milwaukee Sikh Temple killings – mass-casualty incidents can happen anywhere and at any time. A community may not be able to stop such massacres from happening, but the preparedness level of that community can often determine how many victims will survive.
In Aurora, the hospitals involved in the incident, as well as the community’s overall response system, reacted almost exactly as had been expected. Those in charge quickly put their preparedness plans in motion and effectively used their emergency training, which ensured a higher survival rate. By distributing the wounded to several hospitals in the area, rather than inundating a single trauma center, the Aurora first responders demonstrated, at least to some degree, that community planning efforts can be effective even in dealing with traumatic events that cannot be anticipated.
The community response also showed that hospital preparedness requires more than the willingness and ability of an individual hospital to plan and prepare for future contingencies strictly by itself. In today’s world, the individual hospital must be developed within and incorporated into a much larger community-readiness framework.
Events Resulting in Service Loss
In some situations in which sudden events destroy and/or effectively close healthcare facilities, a larger support framework must step up to face the challenge. When there is an overall community-at-large plan in place to react to such events, the harmful effects can still be minimized. Hurricane Irene last summer put many hospitals up and down the U.S. east coast in harm’s way and required some hospitals to temporarily close or evacuate.
The community support provided by other healthcare centers, as well as the community plans already in place to cope with such events, significantly minimized the hurricane’s health-related effects. Moreover, the after-action analyses provided by the affected hospitals affirmed the consensus that hospital emergency planning, combined with the community emergency planning developed over the past decade, had a direct and positive impact on the eventual outcome.
Some federal and state emergency preparedness-grant deliverables, as well as some requirements for hospitals with the Joint Commission accreditation, have required not only that hospitals plan on a broader scale but also share their emergency plans with other hospitals, health centers, and first-responder agencies and organizations within their home communities. Compliance with these requirements is demonstrated through discussions, drills, and actual events and incidents. Time and again, community after-action reports point to planned preparedness as a primary factor in helping the hospitals involved react both quickly and effectively.
The Future Outlook for Hospital Resilience
Because of the projected decrease in or elimination of grant funding, many individual hospitals are left with the following choices: (a) fund their own preparedness plans; (b) cut back on the efforts (and funding) needed to prepare adequately; and/or (c) plan in ways that can allow several hospitals in the same general geographic area to share and mutually benefit from community-wide preparedness funding.
Some of the nation’s larger healthcare systems already have been successful in pooling their hospital resources and allowing them to be used in a total-systems approach. In some areas, non-affiliated hospitals have formed emergency planning groups. New York State, for example, created a number of Regional Resource Centers that coordinate hospital preparedness in various regions throughout the state. In other states, hospital compacts have been developed that not only share equipment and pharmaceutical stores but also, in certain crisis situations, allow the emergency credentialing of medical personnel for working within and between different health systems.
The future will obviously challenge hospitals to strengthen their relationships with other hospitals and even healthcare competitors. Because emergency preparedness promotes resiliency within the healthcare system and does not actually give a competitive edge to individual hospitals, the opportunity and obligation to work together and share resources will almost assuredly continue to grow. With healthcare dollars becoming even scarcer, the voluntary increase in cooperation, combined with a joint community emergency response system, is perhaps the best way to ensure and improve hospital readiness.
Theodore “Ted” Tully is the Administrative Director for Emergency Preparedness at Mount Sinai Medical Center in New York City. He previously served as Vice President for Emergency Services at the Westchester Medical Center (WMC), as Westchester County EMS (emergency medical services) Coordinator, and as a police paramedic/detective in Greenburgh, N.Y. He also helped create the WMC Regional Resource Center, which is responsible for coordinating the emergency plans of 32 hospitals in lower New York State.